THE INVOLVEMENT OF THE SPOUSE IN CARDIAC REHABILITATION

The family, and particularly the spouse, deserve considerable attentio n in the cardiac context. This concern is partly as a support to the r ehabilitative efforts of both patients and of staff but also as an ack nowledgement of the considerable potential for distress and health pro blems among spouses themselves. The literature on spouse problems and concerns following acute cardiac events is described. The first phase of a longitudinal study comparing spouse and patient on quality of lif e and on preceptions of lifestyle change is outlined. On the Quality o f Life Questionnaire for Spouses (QL-SP), spouses of patients starting an out-patient cardiac rehabilitation programme (N=30) reported signi ficantly poorer scores on the emotional concerns dimension than did pa tients. There was no difference in couples' scores on the physical and social concerns dimension. Seven behaviours associated with an unheal thy lifestyle were examined with regard to patient and spouse views on their harmfulness, perceived difficulty (self-efficacy) for the patie nt, and perceived certainty (outcome expectancy) of maintaining the be haviour. The behaviours were smoking, alcohol consumption, regular exe rcise, a low fat diet, body weight control, stress management and adhe rence to prescribed medication. There was general agreement within cou ples on the harm associated with the various behaviours. Spouses were significantly more likely to expect they would be difficult for the pa tient to maintain and, correspondingly, were less certain that partner s would succeed. Both partners rated stress management as being partic ularly difficult and unlikely to be achieved in the subsequent months. Results illustrate a high level of emotional concerns for cardiac spo uses and differing estimates of the rehabilitative demands and potenti al of patients by patients themselves and their spouses. Longitudinal study will document patient and spouse quality of life over time and t he relative predictability of the differing patient and spouse estimat es of patient rehabilitation.